First off, I love treating runners. There are about a hundred reasons for that. For one, runners (like bodybuilders) tend to be very aware of what is going on in their bodies. Secondly, I have first-hand experience suffering from many common running injuries that I see in clinic – so I can relate. Let’s take a look at a few common running injuries.
“Shin Splints” are one of the most common running injuries that I see in my clinic. Shin splints can affect athletes of all ages. While it is often thought of as a novice runner’s injury, experienced runners can also develop them, especially following a change in their training routine.
Patients usually report pain along the middle or lower 1/3 of the inside of their shin, either along the edge of the bone or just behind it. When the pain starts, they usually only feel it after a run. Then, as their condition gets worse, they start to feel pain while running and sometimes it ends up being all the time. (ouch!)
The exact cause of shin splints (also called medial tibial stress syndrome) isn’t fully understood. However, it appears to be due to an irritation of the tissue that attaches the muscles to the bone and / or tight, weak, over-worked muscles in the low leg.
Clinically, when I see shin splints / medial tibial stress syndrome, it is usually the end result of faulty movement patterns and muscle imbalances. Let’s take a look at a couple of these.
First off, I’d like to talk about the posterior tibialis muscle. It’s a long, thin muscle that “lives” behind your shin bone. It’s not a muscle that a lot of people talk about, because it’s hidden and doesn’t show up in bodybuilding poses. But it’s very important for athletes. This is because of how it stabilizes the ankle – and since the foot and ankle are our foundation – the whole body.
The posterior tibialis runs from the back of your two low leg bones (fibula and tibia) to the arch of your foot. When it’s doing it’s job, it does several important things. It helps spread your weight across the width of the arch of your foot. It keeps you from over-pronating while walking or running. It also helps prevent your knees from collapsing inward.
So how does the posterior tibialis get overworked?
To answer this question, we need to look at what’s happening at the other end of the leg – at the hip. Weak hip stabilizers, especially the gluteus medius, can wreak havoc on the ankle, knee, and the muscles that stabilize them. When the gluteus medius muscle is weak, your low leg will collapse / rotate inward when your run, do lunges, etc.
Your body doesn’t want to fall down or otherwise hurt itself, so your posterior tibialis has to work harder to keep your leg straight up-and-down when you stand, workout, walk or run. Over time, this extra effort overworks the muscle and stresses the tissue that hooks it to your leg bones. What’s more, two recent European studies by Verrelst and associates showed that a weak gluteus medius led to shin splints in athletes. Clinically, I find that gluteus medius tests weak in at least 2/3 of runners with shin splints.
Pain along the inside of your shin may also be “referred” from a problem somewhere else. The most common cause of referred pain that I see is from “Trigger Points.” Trigger points are sore spots in tight bands in your muscles. Normally, they shouldn’t be there. Injury, infections, stress, over training and about a hundred other things can cause them to form. In muscles, they usually form where the nerve attaches to the muscle. Trigger points are different from regular tight muscles. Trigger points are basically little inflammation factories. What’s even weirder, trigger points can cause pain and other symptoms in totally different parts of the body – away from where the real problem is.
Occasionally, pain along the inside of the shin is coming from trigger points. More often, I see referred pain from the posterior tibialis and other muscles causing additional pain in the foot, ankle, or Achilles tendon.
So what can I do?
When you come in for your appointment, we’ll check for muscle imbalances and examine how you move when your walk. We’ll look for trigger points that may be mimicing shin splints and rule out other, more serious problems like stress fractures and vascular problems.
We can use orthopedic acupuncture to help correct muscle imbalances and restore proper movement patterns. If trigger points are part of your problem, we will use dry needling acupuncture to deactivate them . Tuina and other soft tissue mobilization techniques help break up any adhesions that might be there. The goal is to reduce inflammation, improve function and restore normal, pain-free movement.
Peroneal Tendonitis (tendonosis, tendinopathy) is another common overuse injury I see in runners. It is an irritation of a group of tendons that stabilize the ankle and “kick” the foot out to the side (pronation / everson) during toe-off. Patients usually come to my office complaining of pain on the outside of their ankle, behind the the pointy bone on the side of the ankle (the lateral maleolus) or on the outside of their foot.
The main causes of peroneal tendonitis are similar to shin splints. The peroneal muscles “kick” the foot out to the side, and support the ankle and arch. When the other muscles that stabilize the ankle, arch, knee and hip aren’t doing their jobs, the peroneal muscles have to pick up the slack. When they’re overworked, their tendons can get irritated. The muscles, themselves, can also develop trigger points, which can also cause pain in the outside of your ankle.
When you come into our office, we’ll take a look at your gait and test for muscle imbalances and restricted range of motion. Usually, I find that people have weak hip abductors / stabilizers, and an imbalace between peroneals and posterior tibialis / long toe flexors. The soleus muscle (a deep calf muscle) is also involved sometimes.
Now, for the good news! Orthopedic electro-acupuncture and dry needling are two of the best tools to quickly restore strength and function, and improve overall sensorimotor integration in your lower extremity. What’s more is that tuina mobilizations and gua sha can help break up fascial adhesions and other issues that may be leading to sub-maximal performance. This means that you can expect more strength, flexibility and stability.
IT Band Syndrome
Iliotibial Band Friction Syndrome (a.k.a. IT Band Syndrome) is another common overuse injury seen in runners and cyclists. Usually, pain starts gradually on the outside of your knee, about an inch above the joint. Over time, the pain may spread up the outside of your thigh or downward to the upper part of your calf. There may also be localized redness and swelling, and the outside of your knee may be sore to the touch.
So what is the “IT Band”?
The Iliotibial Band (a.k.a. IT Band) a band of fibrous tissue – basically a big, thick, wide tendon – that runs along the outside of your thigh. It connects two muscles in your hip area, the TFL and Gluteus Maximus, to the main bone of your low leg and to the outside of your kneecap.
The IT Band helps slow down inward movement of thigh when your foot lands on the ground when running. It’s important to mention that when the knee flexes from straight to being bent about 30 degrees, it gets pressed against a bump on the outside of your thigh bone. When the muscles that pull on your IT band are tight (and often weak), the IT Band can get irritated as it gets dragged over the bone. Repetitive tightening and relaxing of the band can also irritate the underlying tissue. Over time, the IT band or underlying tissue can become inflamed. Usually, the symptoms begin gradually.
There are many things that can cause IT Band Syndrome. As with many other running injuries abnormalities in your gate can make it more likely that you will develop it. For instance, over-pronation and/or over-supination of the ankle, or weak hip stabilizers that allow the thigh and knee to collapse inward can over-stress the IT Band. Bowed legs or having one leg longer than the other can also contribute.
How you train can also cause your IT band to get irritated. For instance, running downhill or on ground that slopes to one side (like the shoulder of the road) can increase the tension on the IT band where it crosses your thigh bone. Cycling with your toes pointed inward also places extra tension on the IT band. As mentioned earlier, over time the repetitive compression or friction can cause the IT band or underlying tissue to become irritated, causing pain.
Trigger points in your thigh muscles can also mimic IT band syndrome – causing pain along the outside of your leg, from the hip down to the middle calf. Sports activities like squats, lunges, Olympic weightlifting, running and jumping can activate these trigger points. They can also be set off by impacts (like getting tackled or getting beaned with a baseball), muscular imbalances or problems in your hip or low back.
The good news is that Dry Needling and orthopedic acupuncture can help. When you come in for your appointment, we will assess for muscular imbalances, trigger points and anything else that may be contributing to your pain. If you’re an athlete, we’ll also take a look at how move when you walk, squat or do other functional movements.
We’ll most likely use orthopedic acupuncture help address the muscular imbalances in you’re low leg and any issues we find in you hip stabilizers. If trigger points are to blame, we’ll use dry needling to help “deactivate” them – allow them to relax and reduce local inflammation.
Treatment of IT band issues usually involves a fair amount of soft tissue mobilization, especially guasha. As with treating other musculoskeletal conditions, the ultimate goal is to restore normal, pain-free movement.
Popliteus Tendonitis / Popliteal Tendinopathy
Popliteus Tendinopathy is an overuse injury that results in the irritation of the popliteus tendon near where it attaches to the outside of your knee. Patients usually complain of pain on the outside of their knee, near where the muscle attaches. The pain may also spread to the back of their knee.
The popliteus muscle is a little muscle on the back of the knee. It wraps around the outside of your knee joint and attaches to a bump on the outside of the end of your thigh bone. It helps unlock the knee when you first start to bend it and generally stabilizes the knee. It also rotates your low leg so that your toes point toward the middle.
Popliteus tendinopathy is relatively uncommon in the general population, but is more common among athletes. Most often, I see it in cross country runners. Usually, it happens because the muscle is working too hard because of muscle imbalances and / or instability of the knee joint.
In my experience, the popliteus muscle responds well to dry needling. When you come in for your appointment, we will also check for muscle imbalances and anything else that may be contributing to your condition.
Plantar fasciitis is a common condition seen in runners that causes pain in the bottom of your heel. It is usually worse first thing in the morning, but may last all day. It can be excruciating and keep you from doing the things you love.
Scientists believe that it is due to unhealthy changes in the tissue that supports the arch of your foot. It can can be caused by many different things, including: trauma, standing on your feet all day, repetitive overuse (like running), tight calf muscles and unhealthy movement patterns. Referred pain from muscles farther up your leg can sometimes add to or even mimic the pain.
When you come in, we will check for muscular imbalances and trigger points that may be causing pain in your feet. Our goal is to restore normal functioning of your leg and foot. This allows your body to heal itself so that you can get back to doing what you love.